Question: We use the online eligibility item checker before all plans are done, however some second 732s are often rejected stating item already paid. We claim the second 732 once we have received confirmation of care collaboration with the allied health provider. We use notations of either not for comparison/not duplicate service etc. and state TCA and a time in notes. We also backdate the second 732 to the date of service. Why does this happen for some of our claims and others go through straight away? Sometimes it will go through if I change the notation.

Answer: 1. Online Eligibility Checker

The online eligibility checker is a helpful tool, but it may not always provide real-time updates on claims that have been recently processed. For instance, if another provider involved in the patient’s care has already claimed a related item (e.g., allied health services linked to the TCA), Medicare may reject your claim with the message “item already paid.”

2. Uncertainty Around Rejections

Many practices have raised this issue, and the truth is that there is no definitive consensus as to why this happens. Variability in Medicare’s automated and manual claim review processes may contribute to accepting some claims while others are rejected, even when they appear to follow the same process.

3. Upcoming Simplification

I am sorry I could not be of much help here. The problem will hopefully disappear soon.

Starting in July 2025, Medicare will simplify the Care Plan and Review item structure. The current separation of GPMP and TCA items will be replaced with a single Care Plan item and a single Care Plan Review item. This change is intended to simplify the process and reduce the confusion and rejection rates currently experienced by practices.

By understanding these factors and preparing for the upcoming changes, practices can better manage current claims and anticipate smoother workflows.